©ASTRO 2004

ABOUTBRAIN TUMORSThe brain is the center of thought, mem-ory, emotion, speech, sensation andmotor function. The spinal cord and spe-cial nerves in the head called cranialnerves carry and receive messagesbetween the brain and the rest of thebody.

There are two types of brain tumors:

• Primary — a tumor that starts in the brain.Primary brain tumors can be benign (noncancerous) or malignant.

• Metastatic — a tumor caused by cancerelsewhere in the body that spreads to the brain.Metastatic brain tumors are always cancerous.

Primary tumors in the brain or spinal cord rarelyspread to distant organs.Brain tumors cause damage because as they growthey can interfere with surrounding cells that servevital roles in our everyday life.

ABOUT ASTROThe American Society for Therapeutic Radiology andOncology is the largest radiation oncology society in theworld. The Society's mission is to advance the practice ofradiation oncology by promoting excellence in patient care,promoting research and disseminating research results.

LEARNING ABOUTCLINICAL TRIALSThe radiation oncology team is constantly exploring newways to treat people with brain tumors through studiescalled clinical trials. Today's standard radiation therapytreatments are a result of clinical trials completed manyyears ago. For more information, please contact the follow-ing organizations:

National Cancer Institutewww.cancer.gov/clinicaltrials

Radiation Therapy Oncology Groupwww.rtog.org

ABOUT THE RADIATION ONCOLOGY TEAMRadiation oncologists are the doctors who oversee the care ofeach patient undergoing radiation treatment. Other membersof the radiation oncology team include radiation therapists,radiation oncology nurses, medical physicists, dosimetrists,social workers and nutritionists. To locate a radiation oncolo-gist in your area, visit www.astro.org/patient.

HELPFUL WEB SITES ONBRAIN TUMORSAmerican Cancer Societywww.cancer.org

American Brain Tumor Associationwww.abta.org

National Brain Tumor Foundationwww.braintumor.org

The Brain Tumor Societywww.tbts.org

National Cancer Institutewww.cancer.gov

RADIATION THERAPY forBRAIN TUMORSUnderstanding YourTreatment Options

ASTROTHE AMERICAN SOCIETY FOR THERAPEUTICRADIOLOGY AND ONCOLOGYTargeting Cancer Care

12500 Fair Lakes Circle, Suite 375Fairfax, VA 22033-3882Phone: 1-800-962-7876 • 703-502-1550Fax: 703-502-7852www.astro.org

GENERAL RISK FACTORS FORBRAIN TUMORSMost brain and spinal cord tumors have no known riskfactors and occur for no apparent reason. There are noknown proven ways to prevent these tumors.

FACTS ABOUTBRAIN TUMORS

The Central Brain Tumor Registry of the UnitedStates estimates that more than 40,000 Americanswill be diagnosed with a primary brain tumor thisyear.This year, an estimated 170,000 Americans will bediagnosed with a brain or spinal cord tumor that hasspread from another part of the body.

TREATING BRAIN TUMORSIf doctors determine that you have a tumor,the treatment options and prognosis arebased on the following factors:

Tumor type.Location and size of tumor. Tumor grade (how abnormal the cells are).Your age, medical history and general health.

If you suffer from any of the initial signs ofa brain tumor, your doctor will likely con-duct some or all of the following tests:

A physical exam to determine your overall health. A neurologic exam to evaluate brain and spinal cordfunction.Imaging studies, such as CT, MRI or PET scans, to look forsigns of a brain tumor. If studies or scans indicate you might have a brain tumor,some tissue may be taken from the tumor to make anexact diagnosis. This test is called a biopsy.A spinal tap may also be performed to look for tumorcells. During this test, a needle is placed in the lower backto obtain a sample of cerebrospinal fluid. This fluid is thenexamined to see if tumor cells are present.

DIAGNOSINGBRAIN TUMORS

UNDERSTANDINGRADIATION THERAPYRadiation therapy, sometimes called radio-therapy, is the careful use of radiation tosafely and effectively treat many differentkinds of tumors.

Doctors called radiation oncologists use radiation thera-py to try to kill tumors, to control tumor growth or torelieve symptoms.Radiation therapy works within tumor cells by damag-ing their ability to multiply. When these cells die, thebody naturally eliminates them.Healthy cells near the tumor may be affected by radia-tion, but they are able to repair themselves in a waytumor cells cannot.

EXTERNAL BEAMRADIOTHERAPYExternal beam radiotherapy involves aseries of daily outpatient treatments overseveral weeks to accurately deliver radia-tion to the brain. Radiation is often givenafter surgery, and sometimes it is usedinstead of surgery.

3-dimensional conformal radiotherapyor 3D-CRT combines multiple radiation treatmentfields to deliver precise doses of radiation to thebrain. Tailoring each of the radiation beams to thepatient's tumor allows coverage of the brain tumorwhile keeping radiation away from nearby organs,such as the eyes.Intensity modulated radiation therapy orIMRT is the most recent advance in the delivery ofradiation. IMRT differs from 3D-CRT by modifying theintensity of the radiation within each of the radiationbeams. Stereotactic radiotherapy, sometimes calledradiosurgery, is a type of external beam radiation thera-py that pinpoints high doses directly on the tumor, insome cases in only one treatment.Proton therapy is given much the same way asexternal beam therapy, but it uses proton particlesrather than X-rays to kill brain tumor cells. This treat-ment is only available in a few regions of the country.

INTERNALRADIATION THERAPYInternal radiation therapy or brachythera-py works by placing radioactive sourcesin or just next to a tumor.

During brachytherapy, a tube or balloon called acatheter will be inserted into the brain. The radiationwill then be carried to the tumor using this catheter.The radioactive source will then be left in place fromseveral hours to several days to kill the tumor cells.In some cases, the radiation is permanently placeddirectly into the tumor or the area where the tumorwas before surgery.

RADIATION THERAPY OPTIONS FORBRAIN TUMORSPeople with brain tumors should discusstreatment options with several cancer spe-cialists, including a radiation oncologist. Aradiation oncologist is a doctor who willhelp you understand the types of radiationtherapy available to treat your tumor.Conventional radiation therapy treatmentoptions for brain tumors include:

External beam radiation therapy. Brachytherapy or internal radiation therapy.

NEWERTECHNIQUESDoctors are constantly exploring newerand better ways to treat primary braintumors.

Drugs that make tumor cells more sensitive to radia-tion are called radiosensitizers. Combining radiationwith radiosensitizers may allow doctors to kill moretumor cells.Chemotherapy is used with radiation to treat somebrain tumors. Your doctor may recommend that youconsult with a medical oncologist (chemotherapydoctor) before starting radiation.

POTENTIALSIDE EFFECTSThe effects of brain radiation can varydepending on your tumor and the tech-nique used to treat it.

Before treatment, your radiation oncologist will dis-cuss any side effects — however rare — you mayexperience.Possible side effects can include fatigue, change inappetite, headaches, visual changes, hair loss, skinirritation, nausea, vomiting and/or unsteadiness. Some side effects can be treated with steroids orother medications. Talk to your doctor about anyproblems you experience.

SIGNS OF BRAIN TUMORSNo blood test or other screening exam candetect brain tumors, but there are oftensome outward signs. While tumors in differ-ent parts of the central nervous systemdisrupt different functions, some symptomsinclude:

Headaches.Nausea/vomiting.Seizures.Weakness or numbness on one side of the body.Changes in vision, hearing or sensation.Difficulty with speech.Lack of coordination.A change in mood or personality.Memory loss.